Post-traumatic Stress Disorder Amongst Cultures

Chiappelli, Iribarren, Neagos, and Prolo described post-traumatic stress disorder (PTSD) as a mental disorder derived from an individual experiencing or witnessing a life-threatening occurrence (2005). However, the continued study of PTSD has redefined the definition to an individual involved in any type of trauma. Back, Gros, Lancaster, and Teeters concluded an individual must experience specific symptoms in four categories over a month long period (2016). The symptoms cannot be attributed to medication, medical conditions, or substance abuse (2016). The four categories consist of the following; the first group is known as re-experiencing symptoms which include nightmares, flashbacks, recurrent memories, the second group is called avoidance symptoms which encompasses avoiding feelings, thoughts people, and location associated to the event, the third category encompasses counterproductive changes in mood and thoughts which include a skewed perception of oneself and/or the world, shame, guilt, feeling of numbness and alienation, and the failure to remember important details of the event, and the last area involves the individual’s personality becoming altered to include a change in irritability, becoming reckless, the inability to achieve quality sleep, inability to concentrate consistently, and the increase in hypervigilance.

History lacks records of individuals suffering from the above symptoms in times of conflicts and life threatening situations. Does this mean PTSD is a new phenomenon or was it not documented due to a lack of awareness at the time? Previously, in America during and after wars, prior to the Vietnam War, the focus was not on the psychological status of an individual but more the physical ailment of the military member sent to fight. The first focus of PTSD resulted from the Vietnam War however, another area pathed the way to continue further research on PTSD (Good et. al, 2015). This was the traumatic events which occurred in children. These events included sexual trauma, incest, and domestic violence. Throughout the time of expanding the psychological effects of trauma, the American culture experienced a phase of denial that lasted from 1950’s to the 1970s, then transitioned to the validation phase from 1970’s-1990’s, lastly, Americans reacted in backlash to families created in incest, sexual abuse towards children, and rape in general (Good et. al, 2015). In the case of the U.S. the broadening awareness and education is conducive to incorporating a healthier life for individuals diagnosed with PTSD. The stigma once attached to PTSD is fading in the horizons and acceptance and understanding are replacing it.

Now, in Oaxacan, Mexico mental illness diagnosis has been on the rise in the past 20 years to include PTSD. Since, the 1990’s more psychiatric and psychological services are made available throughout the city. Although, the PTSD definition has changed to include any trauma, Mexican culture does not view it this way. Many cases of domestic abuse are coming forefront due to the arising psychological services available. Although, domestic abuse has tertiary affects and it was a focal point in the inception of PTSD, domestic violence is viewed as a “cultural problem” and women are not diagnosed with PTSD, however, the survivors of PTSD can be diagnosed with symptoms of PTSD. A woman by the name Amapola, described how growing up in domestic violence her whole life shaped this type of act as normalcy and although she felt many symptoms of PTSD she continued through life living as if this is how a woman is supposed to live (Good et. al, 2015). Once she read a billboard sign advocating for a world without violence with a phone number attached to it, her idea views have changed and she is now able to address her symptoms of isolation, anger, helplessness, out casted, vulnerability, and low self-esteem. More education is found in cities however, in many rural areas the ignorance is embedded even deeper engraining domestic abuse as part of their customs (Good et. al, 2015). Mexico interprets PTSD as being extraordinary acts outside of common occurrences therefore domestic violence is engrained into Mexican society is a disqualifier for PTSD. In Mexico, by increasing the overall ability to receive help for psychological disorders for individuals qualifying having PTSD, can receive help and have a better qualitative of life. However, for the individuals of domestic abuse their cause can be generated even further if individuals are categorized as having PTSD. This could project a faster reform for equal rights for women.

A third culture where PTSD has had a lot of visibility is within the military the past few decades. Being a Soldier from 2005 to present I have witnessed the cultural change revolving around this topic. In 2005, if an individual was known to visit behavioral health there was a negative connotation attached to them. This was emphasized even more with Soldiers who held security clearances. In order to maintain a security clearance a review is conducted after a specified amount of years depending on the clearance held. The negative connotation added with the fear of losing your security clearance prevents Soldiers from asking and receiving psychological help. This caused Soldiers to work through their issues on their own. For some this was difficult but they managed, for others they could not help themselves therefore turning to violence, murder, and/or suicide. As years have passed I witnessed how our culture changed. The stigma attached to seeing a psychologist is fading in the background. The fear of losing a clearance is not as prevalent is education is coming to the forefront of what flags are alarming to investigators when you are up for renewal of your security clearance. Now, more than ever Soldiers are not only getting the help they need through command directive but they are self-referring themselves to obtain the skills they need to live with the experiences they endured. In the Army research, understanding, and desire to help is shaping the culture to embrace a healthier life physically, emotionally, and mentally.

Within the American culture external obstacles PTSD faces is the amount of information still unknown regarding the topic, the inability for individual’s to receive help, i.e. health insurance to pay for the help, etc. Some internal obstacles are the beliefs an individual holds regarding receiving help. Many people think they can do it on their own, they do not trust psychologist/psychiatrist, fear of will happen if they receive help, etc. Some of the areas which enable traumatic experiences are rural areas like the ones aforementioned within Mexico. This is the perfect environment to not only perpetuate traumatic events from generation to generation but also validate its presence through ignorance. In this instance the sewing of traumatic events weaved into daily life creates a quilt of normalcy no one thinks to question and everyone embraces regardless of the outcome. The main obstacles here are lack of awareness throughout the community, facilities set up to help people, and the acceptance ingrained in people within the community. Lastly, within the Army some of the internal struggles still occurring is fear of losing your job due to ignorance of the process, thinking they can handle themselves, idea of looking weak in seeking help especially in an environment where we are all supposed to appear strong. Some of the most amazing feats the Army has been done is removed most external obstacles. They have worked with civilian psychologist and psychiatrists and developed Master Resiliency Training, they pushed the encouragement to seek help if you need it, the commands address and educate Soldiers on their concerns regarding the loss of security clearances, they give suicide training and provide hotlines for people to call if they need help, they give sexual assault and sexual harassment classes, and encourage individuals who have experienced that trauma to seek help through anonymous channels and/or filing a formal investigation on the situation, whatever the individual is comfortable with. With the change in the military social change follows.

The question is what change needs to occur to provide aid to individuals with PTSD on a global scale and what factors need to be considered? First and foremost, there is not one solution which will work for every culture. There is doubt within the psychology field when approaching a “psychological universality” towards cognition, emotion, motivation, and interpersonal/social regulation. This is due to the type of communication used. Not all cultures communicate the same or use the same type of vernacular/gestures to get a message across or have the same methods for healing. There needs to be cultural awareness and sensitivity when conducting studies. Although, having one approach towards each specific culture may not be realistic due to the daunting nature enveloped, there may be times when similar cultures can be combined and one approach may work. Since the West has been a heavily studied area many areas globally have not been exposed to what PTSD is, how it can effect one’s life, and how to cope with it universal education needs to occur in conjunction with studies of individuals in their natural environment. There are piloted studies of refugees outside of their natural environment, but this creates a false illusion of what their reality will be if they return home and if the methods are successful in their natural environment (Cahill et. al, n.d.). Developing a way ahead for healthcare should also be taken in consideration when educating different cultures on physical and mental issues and providing a system for healing conducive to their culture. There are research groups currently addressing these concerns. Some are World Health Organization (WHO), Friendship Bench program in Zimbabwe, group interpersonal psychotherapy, etc.

In conclusion, PTSD is a mental condition many people deal with every day which can be life-threatening and was born from a traumatic event. Although it is relatively new and much understanding is still needed in order to facilitate a global effort to address the problem change is occurring, measures are being taken to bring awareness, and help is becoming available more and more. As education and awareness travels the obstacles some currently face may be lifted, i.e stigmas, availability to seek help, cultures changing, individual strength is discovered, etc. Groups like WHO are already forming and embarking on permanent solutions for individuals with mental health issues.

References

• Back, S. E., Gros, D. F., Lancaster, C. L., & Teeters, J. B. (2016, November 1). Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Retrieved February 14, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126802/
• Cahill, S. P., & Foa, E. B. (n.d.). Handbook of PTSD, First Edition. Retrieved February 14, 2019, from https://books.google.com/books?hl=en&lr=&id=zCEs1Rn6Dh8C&oi=fnd&pg=PA55&dq=different theories of psychological for ptsd&ots=mfF7oM8rqn&sig=Pc7G0Q-2a_nz1zIgnoDIKZwjBhU#v=onepage&q&f=false
• Chiappelli, F., Iribarren, J., Neagos, N., & Prolo, P. (2005, December 1). Post-Traumatic Stress Disorder: Evidence-Based Research for the Third Millennium. Retrieved February 14, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297500/
• Good, B. J., & Hinton, D. E. (2015, December 3). Culture and PTSD : Trauma in Global and Historical Perspective. Retrieved February 14, 2019, from https://login.ezproxy2.apus.edu/login?url=https://ebookcentral.proquest.com/lib/apus/reader.action?docID=4321844
• Heim, E., Kirmayer, L., & Maercker, A. (2019). Cultural Clinical Psychology and PTSD. [online] Pubengine2.s3.eu-central-1.amazonaws.com. Available at: https://pubengine2.s3.eu-central-1.amazonaws.com/preview/99.110005/9781616764975_preview.pdf